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We Weren't the Only Ones Who Noticed (Her Achievement)

August 14, 2008
by Mark Hagland
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When we chose the industry-leading folks at Brigham and Women’s Hospital in Boston to grace our cover this month, because of their pioneering work in applying business intelligence tools to clinical care improvement, we weren’t the only ones noticing their caliber of innovation. It turns out that CIO Sue Schade has just been recognized as one of CIO Magazine’s “2008 CIO 100 Winners.” As our cover story points out, Schade has worked very extensively with colleagues Michael Gustafson, M.D., Tejal Gandhi, M.D., and others at the hospital’s Center for Clinical Excellence to vastly and systematically improve patient safety and care quality. CIO recognized Schade’s accomplishments by naming her one of 100 CIOs nationwide, across all industries, deserving of recognition for their accomplishments. The magazine’s editors noted that “Brigham and Women’s Hospital was among the first healthcare organizations to implement the Balanced Scorecard to improve hospital performance, The hospital used SAS Strategic Performance Management for Healthcare to improve health services, patient experience and business management.”

What’s more, Schade wasn’t the only healthcare CIO to make the list. Michael Nguyen of the California Department of Health Care Services, Jeff Kessler of the Dana-Farber Cancer Institute, Gregory Veltri of the Denver Health and Hospital Authority, Thomas Lauzon of Health Plan of Michigan, Detlev (Herb) Smaltz of Ohio State University Medical Center, Michael Krouse of OhioHealth, Bert Reese of Sentara Healthcare, Gerry Lewis of Seton Healthcare Network, Edward Marx of Texas Health Resources, Dan Drawbaugh of the University of Pittsburgh Medical Center, Craig B. Luigart of the Veterans Health Administration, Lori Beer of WellPoint, and Jeff Keisling of Wyeth also made the list, for a very wide variety of innovations. And they joined 86 other CIOs, from companies as diverse as Accenture, Aflac, ATandT, BP, Cisco Systems, Coca-Cola, the District of Columbia Water and Sewer Authority, General Motors, Lockheed Martin, and Marriott International, all of whom are creating strategic innovations in their industries.

To me the fact that 14 of the 100 CIOs named by the magazine came from some area of healthcare is very significant. As with everything we at Healthcare Informatics do, it is clear that a great deal of innovation is taking place across the healthcare industry. It is highly gratifying for me when our coverage is further validated by other sources. Congratulations to Sue Schade and all the other healthcare CIOs on that list, and may the innovation continue!

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Since publication of the IOM's groundbreaking reports outlining the prevalence of preventable medical errors and the actions that can be taken to significantly reduce them, U.S. healthcare industry leaders have made significant investments in clinical process, technology and organizational infrastructure to improve quality and patient safety. And significant additional investment is anticipated to be required in the foreseeable future.

Have you noticed how much everyone wants to find "some way" to measure Quality of Care? And the benefits of Evidence Based Care? And the financial impact of improved Quality? And, have you noticed that the best that people are able to do is bring anecdotal evidence...a few examples...some case studies...some hypotheses about the relationship between clinical process and clinical outcomes? Almost every presenter at the most recent Zynx Health Conference in San Diego brought illustrations of benefits — clinical, operational and financial — yet the resemblance they bore to each other was coincidental, at best.

We believe the reason for this is that the science of Hospital Quality Management is relatively immature. Hospital Financial Management, by contrast, is very mature, as evidenced by things like standard financial statements, consistent charts of accounts, universally accepted metrics and measurements, easy benchmarking, etc. Comparable capabilities are not possible in the current world of Hospital Quality Management — not for lack of demand or desire, but for lack of commonly agreed-upon definitions, metrics, and reporting mechanisms.

My Firm's point of view is that to truly "move the needle" on quality, an organization must begin by clearly defining and it. While there is no standard healthcare industry definition of what constitutes "quality," we have found that top healthcare performers adopt a balanced composite of measures that consider:

Clinical Outcomes: Ultimately it is the outcome that matters most. Risk adjusted healthcare quality measures such as inpatient mortality rate, readmission rate, complication rate are commonly accepted indicators of quality outcome success.

Clinical Process: Effective clinical processes are essential to achieving superior healthcare quality outcomes. At a minimum, current publicly reported "core measures" should be considered. Evidence based physician order sets and clinical care plans provide a rich assortment of additional quality process measures.

Patient Experience: An excellent starting point for this would be to use the CMS Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measures. These can be supplemented with additional information from your patient satisfaction survey.

Resource Utilization: "Too little" or "too much" care can adversely affect outcomes. Measures such as risk adjusted average length of stay, ICU ALOS, and cost per case are examples of effective resource utilization indicators.

Top performing organizations not only define and measure healthcare quality, they ask the question: "How are we doing?"

We believe that the best way to answer that question is to compare your organization's results to those of "Top Performers." There are a number of organizations that provide excellent health care industry clinical quality and financial benchmark information. Through benchmarking, organizations are able to identify their strengths and weaknesses, and develop strategies to address and overcome healthcare quality gaps.

Benchmarked performance ratings on individual measures can then be weighted and rolled up to measure overall quality performance for individual conditions (e.g. pneumonia vs. AMI, individual hospitals within a health delivery system, or a system - wide composite score.

Many Top Performers establish quality performance goals, and compensate their leaders on degree of goal achievement.

Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...